Mikey, a blonde 5-year-old with sparkling blue eyes, is having a tantrum in the middle of a food store. He points to a red balloon dangling by a long, shiny string floating near an air vent in the ceiling. People begin to stop and stare at the child while his mother ignores the behavior.

Mikey loves balloons, but he especially loves long pieces of string. He is also fascinated by the television, but only when it is turned off. He hates the sounds of sirens, alarms and thunder, and screams incessantly when put in the bathtub.

But Mikey can run, climb and balance better then most children his age. He can complete puzzles with amazing speed. Yet Mikey is non-verbalhe flaps his hands when he becomes excitedand he is not yet toilet trained. Mikey has autism.

How does one work with a child such as Mikey, who has limitedif any–language and atypical sensory-processing abilities in addition to significantly impaired social skills? Today, therapists can treat children diagnosed with autism using applied behavioral analysis (ABA), a concept developed by Dr. O. Ivar Lovaas.

ABA is one of the most widely known, effective and accepted intervention plans for children with autism (Rosenwasser & Axelrod, 2002). The focus is to increase appropriate behaviors and decrease or eliminate inappropriate behaviors by teaching small, measurable units of behavior systematically. Many children who receive intensive ABA intervention at an early age have shown progress in their social, communication, behavioral, academic and daily living skills (Maurice, Green, & Luce, 1996).

ABA intervention strategies focus on antecedent conditions that can trigger a problem behavior, and provide insight after the problem behavior has occurred. By manipulating the environment, observing behaviors and individualizing the ABA program, a teacher can teach and then reinforce the wanted behaviors (Yapko, 2003).

ABA uses a functional behavioral assessment (FBA) and discrete trial training (DTT). Discrete trials (DT), the teaching unit used in ABA programs, consist of a stimulus, a response and a reinforcer. "Prompting" (adding a physical, verbal, positional, visual or gestural stimulus to a situation that increases the chance that a desired behavior or response will occur), "shaping" (reinforcing a behavior after each "successive approximation" of the targeted behavior), "fading," and "generalization" are terms frequently associated with ABA (Richman, 2001, p.34).

An FBA is used to determine an antecedent, identifying the child's measurable response or problem behavior, and noting the consequence (Tsai, 2001). Determining the antecedent will help the observer figure out the probable reason for the child's response or problem behavior. Identifying the problem behavior, through child observation and/ or caregiver/teacher interview, is an essential feature of the FBA process because it helps the instructor determine how to target and manage the problem behavior. The consequences may include reinforcers, punishers or neutral events.

DTT is one type of instructional methodology often used in ABA-based programsit breaks down a complex task and teaches it to the child systematically. Each trial consists of a discriminative stimulus (Sd), a response from the child (R), and a reinforcement (Sr). The Sd is an instruction given to the child by the discrete trial instructor (e.g., teacher, caregiver, therapist). The Sd can be a verbal, visual, tactile or gestural instruction.

There are two types of Srs: positive and negative. A positive Sr causes a behavior to increase in frequency. Rewarding a child with a pretzel after he correctly answered a trial question is an example of a positive Sr (See chart). A negative Sr is the removal of an aversive stimulus: removing a tag in a child's T-shirt because it is itchy, for example.

It is important to present the Sr immediately following the targeted behavior. This helps the child make a connection between the two. The instructor should then fade the Sr by decreasing the frequency that it is given, hoping that the child will be able to do the targeted behavior with fewer prompts each successive time. The goal is that he display the targeted behavior across all environments with the least amount of Sr. A child who can take what he has learned in one setting and apply it consistently across various environments has learned the skill of generalization.

However, generalization is often a challenge for children with autism, as they are usually concrete learners. For example, during a DT, the child with autism may be able to write his name correctly but he cannot yet write it on different media (lined paper, chalkboard, construction paper), across multiple environments (school, home, friend's house), using a variety of writing implements (pen, pencil, crayon) and/or with different instructors providing the Sd and with various Sds for "writing name."

Generalization and functional use of a learned skill should be the focus of any intervention plan, as it helps a child become more independent in his daily life activities.

So what's happened to Mikey, the little boy who was introduced earlier?

Well, after many years of intensive ABA intervention, I'm happy to say that Mikey has been mainstreamed into a fourth-grade classroom. His mother, teacher and classmates recently celebrated his 10th birthday at school, with cupcakes and bright red balloons, each attached to a long piece of string.

Elisa Pomeranz works in the school system on Long Island. She has a great deal of experience working with children with autism and other PDD.

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